Navigating the MPMR

Adam La Caze
School of Pharmacy
The University of Queensland

Background

Objectives (Overall)

  1. Understand the purpose and contents of the MPMR in the context of nursing and midwifery practice
  2. Be able to navigate the MPMR
  3. Be able to determine how a medicine needs to be prescribed, dispensed and administered to be in accordance with the law.

This section of the module…

We focus on the second objective

Be able to navigate the MPMR

This is critical if you are going to achieve Objective 3: using the MPMR to assess whether a medicine has been legally prescribed, dispensed and administered.

Key concepts

  1. Know key legal definitions provided by the MPMR: approved person, dealing, extended practice authority
  2. Know key activities (dealings) that can be authorised: e.g. supply, administer, dispense, prescribe

Getting around the MPMR

Medicines and Poisons Regulatory Framework

Queensland Health provide a website that brings together links to the key legislation, supporting documents and fact sheets

Open the MPMR

Open a version of the MPMR on your computer. It is best to save a .pdf version (there is also a .pdf version of the legislation in the Blackboard folder).

Really. Do it now!

You need to be able to navigate and interpret the MPMR.

The best way to achieve this is to work with the document. For the rest of these slides I assume you have a .pdf version of the regulations open in an adjacent window.

Structure of MPMR

The best way to navigate the MPMR is via the table of contents, which is embedded in the .pdf meta-data.

Any good pdf reader should allow you to open the table of contents. What you have open should look like this:

MPMR with embedded table of contents on the right

Chapters and Schedules

Chapters provide key definitions and the requirements on particular activities (dealings).

For example, Chapter 4, Part 6 provides requirements for prescribing medicines. This includes s86 that stipulations the information that needs to be on a prescription.

Schedules link approved persons (e.g. particular health professions) with the activities (dealings) that they are permitted to undertake.

For example, Schedule 7, Division 2, s11 states that a registered nurse can administer an S4 or S8 medicine on a prescription.

Key concepts for understanding the MPMR

Definitions and interpretation

A lot of distinctions are made in the MPMR. Some are defined externally, e.g. medicine schedules, Act (MPA), others are defined within the MPMR.

Definitions can be found in Schedule 22, Dictionary. Some key terms are defined in the Medicines and Poisons Act 2019 These terms are also provided in Fact Sheets.

It is important to refer to these definitions as you work with the MPMR—some of the distinctions are subtle.

Authorisations and approved persons

Authorisations define approved persons.

Approved persons are members of a class of persons (e.g. particular health professions) who are permitted to undertake particular dealings with medicines within the regulation.

Dealings

Dealings are the particular activities that approved persons are authorised to undertake.

The MPMR stipulates how some dealings need to be undertaken.

Common dealings are: manufacture, buy, posses, supply, dispense, administer, prescribe

Schedule 7, Nursing and midwifery professions

Have a look at Schedule 7 of the MPMR.

Note the different “approved persons”: nurse practitioners, midwives, endorsed midwives, registered nurses, …

Compare the different dealings that are authorised by the different professions.

Summary

Term Explanation
Authorisation The identification of an approved person (e.g. a health professional) as someone that can carry out a specific activity (a “dealing”)
Dealings An activity that is permitted with a medicine, e.g. manufacture, buy, posses, supply, dispense, administer, prescribe.
Authorised way An approved person dealing with a medicine in a way that is consistent with the MPMR
Extended practice authority Extended Practice Authorities state additional dealings that an approved person can undertake. The documents sit outside the MPMR, but are approved by the MPMR. This provides some additional flexibility in regulating additional roles that specific professions can do: there are extended practice authorities for midwives, registered nurses and other health professionals

Supply, dispense, administer, prescribe

Each of these terms are defined in the Medicines and Poisons Act 2019 (MPA) (references refer to this document).

Supply (s24, MPA)

means to sell or give the substance to a person (this includes the following s25, MPA)

Sell, a regulated substance, includes the attempt to sell the substance or make the substance available for sale

Dispense, a medicine, means sell the medicine to a person on prescription

Give a treatment dose, of a medicine, means give 1 or more doses of the medicine to a person to be take by a particular person, or administered to an animal

Administer (s26, MPA)

means (a) introduce a dose of the medicine into the body of a person or animal by any means; or (b) give a dose of the medicine to a person to be taken immediately

However, administer, a medicine does not include dispensing the medicine.

Prescribe (Dictionary, MPA)

in relation to a medicine, means direct a person, orally or in writing, to administer, dispense or give a treatment dose of the medicine for the treatment of a person or animal

Dispense v give a treatment dose

Dispense and give a treatment dose are two different types of supply.

How do they differ?

How do these types of suppler differ from administration?

This distinction is tricky. The definitions by themselves don’t quite get at it.

The key issue is who is authorised to dispense and give a treatment dose

Contrast Rural and isolated hospital nurses (Schedule 7, Division 4, s15) with Pharmacists (Schedule 9, Part 1, Division 1, s2)

Pharmacists are authorised to dispense medicines.

Rural and isolated hospital nurses are authorised to give treatment doses in certain situations.

Dispense and supply v administer

Determine which of the following professions can administer controlled drugs: doctor, enrolled nurse, pharmacist.

Notice the differences in scope between these professions

Categories of medicines

MPMR includes additional categories of medicines that have additional restrictions (over and above their schedule).

These are restricted medicines, high-risk medicines, diversion-risk medicines and monitored medicines.

Restricted medicines are a small group of medicines that are most safely used by particular medical specialities or in particular circumstances.

High-risk medicines have an increased risk of misuse.

High-risk medicines are monitored (a real-time record is made of prescribing and dispensing).

MAPR medicines categories with examples
Category Description Examples
Restricted medicines Medicines that are restricted to specific specialities, or particular circumstances Clomiphene, clozapine, etretinate
High-risk medicines Medicines identified as potentially presenting a high risk of harm to patients as a result of misuse, abuse, diversion, substance use disorder and/or overdose S8 medicines, benzodiazepines, codeine, gabapentin, pregabalin, quetiapine, tramadole, zolpidem, zopiclone
Diversion-risk medicines Medicines at high-risk of misuse and/or diversion High-risk medicines plus growth hormones, ephedrine, anabolic steroids, and more
Monitored medicines High-risk medicines designated as requiring real-time monitoring Same list is High-risk medicines

The addition of high-risk and monitored medicines is an important and recent change in the legislation.

These regulations recognise the risk that opioids and similar medicines pose and seek to reduce the risk of these drugs to the public.

Summary

You should now be able to get around the MPMR.

Use these skills. If you want to know what the law is find it and read it, and if necessary seek advice on how to interpret it.

Do the quiz! Then start the next section of the module.